Medicare Enrollment Period Changes and Medicare Advantage Updates Gail Sexton; Ray Swisher; and Deme Umo, CMS

New Changes to Enrollment Rules CMS Updates and Medicare Enrollment Period Changes and Medicare Advantage Updates 8/21/2018 New Changes to Enrollment Rules Enrollment for Medicare Parts C & D Center for Medicare/Medicare Enrollment & Appeals Group, and Medicare Medicaid Coordination Office Deme Umo, CM/MEAG Gail Sexton CM/MEAG August 2018 Garner and Sexton, Ballroom on 08212018 1040 and 1100 no repeats

New Enrollment Changes CMS Updates and Medicare Enrollment Period Changes and Medicare Advantage Updates 8/21/2018 Regulation CMS-4182-F, published 4/16/18 Impacts MA, Part D and Cost plans Effective 1/1/2019 Subregulatory guidance issued 7/31/2018 Garner and Sexton, Ballroom on 08212018 1040 and 1100 no repeats

Regulation Changes Duals/LIS Special Enrollment Period (SEP) Changes CMS Updates and Medicare Enrollment Period Changes and Medicare Advantage Updates 8/21/2018 Duals/LIS Special Enrollment Period (SEP) Changes Limitation for at-risk beneficiaries MA Open Enrollment Period Seamless Conversion/Default Enrollment Passive Enrollment Garner and Sexton, Ballroom on 08212018 1040 and 1100 no repeats

Duals/LIS SEP Limitations CMS Updates and Medicare Enrollment Period Changes and Medicare Advantage Updates 8/21/2018 Currently, SEP for duals/LIS-eligible is ongoing Starting 1/1/2019, this particular SEP can only be used once per calendar quarter during the first three quarters of the year (January – September) AEP can be used in the 4th quarter Garner and Sexton, Ballroom on 08212018 1040 and 1100 no repeats

Duals/LIS SEP Limitations (continued) CMS Updates and Medicare Enrollment Period Changes and Medicare Advantage Updates 8/21/2018 Comprehensive Addiction and Recovery Act (CARA) established drug management programs Individuals who have been notified that that they are “potentially at risk” or “at-risk” under a drug management program cannot use the dual/LIS SEP Limitation lasts until the “at-risk” determination expires or is terminated by the plan Other election periods are still available – AEP, other SEPs Garner and Sexton, Ballroom on 08212018 1040 and 1100 no repeats

New Part D SEPs SEPs established for the following groups: CMS Updates and Medicare Enrollment Period Changes and Medicare Advantage Updates 8/21/2018 SEPs established for the following groups: Those who have been assigned into a plan by CMS/State (e.g., auto-assignment, reassignment, passive enrollment) Those who gain, lose, or have a change in their dual/LIS status These two SEPs are separate from the dual/LIS SEP Garner and Sexton, Ballroom on 08212018 1040 and 1100 no repeats

SEPs Finalized in CMS-4182-F CMS Updates and Medicare Enrollment Period Changes and Medicare Advantage Updates 8/21/2018 1. Dual SEP -- §423.38(c)(4) 2. Change in LIS -- §423.38(c)(9) 2. Change after CMS/State initiated enrollment -- §423.38(c)(10) Detail For full/partials duals to use onetime per calendar quarter during the first nine months of the year to enroll in a new plan or disenroll from the current plan For full/partial duals who gain, lose, or have a change in Medicaid/level of LIS to enroll in a new plan or disenroll from the current plan For beneficiaries (primarily full/partial duals) being enrolled in a plan by CMS or a State (i.e., auto enrollment, facilitated enrollment, passive enrollment,  or reassignment). CARA: Available for Potential at-risk or at-risk beneficiaries? No – Eligibility for dual SEP is voided if a beneficiary is identified as potentially at-risk or at-risk by their current plan, but they can still use other available election periods (e.g., AEP, OEP, etc.) Yes Frequency One allowable election for each of the following time periods: January –March, April – June, and July – September. Onetime use separate from other SEP opportunities. If bene has multiple Medicaid/LIS status changes in a calendar year, the SEP could be used multiple times Onetime use separate from other SEP opportunities. If bene is assigned more than once in a calendar year, could be used multiple times. SEP starts 1/1, 4/1, 7/1 Upon notification of change in LIS or dual eligibility Upon notification of assignment to another plan. SEP ends At end of 3 month period or Upon use (application date ) Three months after change of LIS or dual-eligibility or, of being notified of the change, whichever is later Three months after notification of assignment or assignment effective date, whichever is later. (Is not considered “used” if bene opts out of assignment and reverts to their original plan (i.e., cancellation).) Effective date First day of the month following election (prospective only) Garner and Sexton, Ballroom on 08212018 1040 and 1100 no repeats

MA Open Enrollment Period CMS Updates and Medicare Enrollment Period Changes and Medicare Advantage Updates 8/21/2018 MA Disenrollment Period ended 2018 MA Open Enrollment Period starting in 2019 January 1 – March 31 each year Must be in MA plan on 1/1 to use MA OEP New Medicare beneficiaries who enroll in MA during IEP have 3 months to use MA OEP to make a change Garner and Sexton, Ballroom on 08212018 1040 and 1100 no repeats

MA Open Enrollment Period (continued) CMS Updates and Medicare Enrollment Period Changes and Medicare Advantage Updates 8/21/2018 People in an MA Plan on January 1 can: Switch MA plans - Can add or drop Part D coverage Leave MA to join Original Medicare - coordinating Part D SEP if go to FFS Part D not guaranteed Can’t use MA OEP if enrolled in Original Medicare, or PDP, Cost, PACE or MSA plans Garner and Sexton, Ballroom on 08212018 1040 and 1100 no repeats

Seamless Conversion/Default Enrollment CMS Updates and Medicare Enrollment Period Changes and Medicare Advantage Updates 8/21/2018 Default enrollment only permitted from Medicaid Managed Care plans into D-SNP under same organization when beneficiary is first eligible for Medicare Plan must request and get CMS approval before implementing default enrollment State determines if MA plan can do default Advance notification with 60-day opt-out Coverage in MA plan starts the same day as A/B Garner and Sexton, Ballroom on 08212018 1040 and 1100 no repeats

Simplified (opt in) Enrollment Mechanism CMS Updates and Medicare Enrollment Period Changes and Medicare Advantage Updates 8/21/2018 Optional process for MA organizations that offer both MA plans and non-Medicare coverage (in place of default enrollment) Generally permits plans to collect only the information they don’t already have for the MA enrollment Plans may offer simplified enrollment via paper, telephone or electronically Available only to those in their ICEP (newly eligible for Medicare- must have both A & B) No break between non-Medicare plan and MA plan Can use MA OEP to change after enrollment starts Garner and Sexton, Ballroom on 08212018 1040 and 1100 no repeats

Passive Enrollment CMS Updates and Medicare Enrollment Period Changes and Medicare Advantage Updates 8/21/2018 Expanding to dually eligible beneficiaries currently enrolled in a non-renewing integrated D-SNP into another integrated D-SNP To be conducted in consultation with a state Medicaid agency Garner and Sexton, Ballroom on 08212018 1040 and 1100 no repeats

Passive Enrollment (continued) CMS Updates and Medicare Enrollment Period Changes and Medicare Advantage Updates 8/21/2018 Receiving plan requirements include: High level of integration Quality standards Premium and cost sharing limits Similar benefits and provider network Beneficiaries will receive: 60 day and 30 day notice of passive enrollment Passive enrollment SEP in addition to other SEPs Garner and Sexton, Ballroom on 08212018 1040 and 1100 no repeats

Election Periods to Enroll CMS Updates and Medicare Enrollment Period Changes and Medicare Advantage Updates 8/21/2018 Election Period Occurs From Coverage Starts Notes Annual Election Period October 15 – December 7 January 1 Plan marketing begins on Oct. 1 Non-Renewal SEP December 8 – end of February First of the month after request is made If no election made by 12/31, individual will be in Original Medicare and lose Part D Medicare Advantage Open Enrollment Period January 1 – March 31, or 3 months after initial entitlement Must have MA. Can switch to any MA plan (except MSA), or go to Original Medicare. If go to Original Medicare, have SEP to enroll in Part D plan. Can add or drop Part D when switching plans. Garner and Sexton, Ballroom on 08212018 1040 and 1100 no repeats

Election Periods to Enroll (cont.) CMS Updates and Medicare Enrollment Period Changes and Medicare Advantage Updates 8/21/2018 Election Period Occurs From Coverage Starts Notes 5-Star SEP For enrollments effective during the year in which that plan has the 5-star rating First of the month after request is made Only enroll into a 5-Star Plan. Part D coverage not guaranteed. SEP for Dual Eligible Individuals Ongoing - One use per calendar quarter during the first nine months of the year Cannot be used by “at-risk” or “potentially at-risk” beneficiaries. Other SEPs Varies based on situation, like residence changes, Special Needs status, etc. Varies Garner and Sexton, Ballroom on 08212018 1040 and 1100 no repeats

Enrollment Period Hierarchy MA ICEP/IEP-D MA OEP SEP AEP OEPI Part D IEP for Part D MA OEP SEP AEP

References Medicare Managed Care Eligibility and Enrollment CMS Updates and Medicare Enrollment Period Changes and Medicare Advantage Updates References 8/21/2018 Medicare Managed Care Eligibility and Enrollment https://www.cms.gov/Medicare/Eligibility-and-Enrollment/MedicareMangCareEligEnrol/index.html Chapter 2 - https://www.cms.gov/Medicare/Eligibility-and-Enrollment/MedicareMangCareEligEnrol/Downloads/CY_2019_MA_Enrollment_and_Disenrollment_Guidance.pdf Chapter 17-D - https://www.cms.gov/Medicare/Eligibility-and-Enrollment/MedicareMangCareEligEnrol/Downloads/CY_2019_Cost_Plan_Enrollment_and_Disenrollment_Guidance.pdf Medicare Prescription Drug Eligibility and Enrollment - https://www.cms.gov/Medicare/Eligibility-and-Enrollment/MedicarePresDrugEligEnrol/index.html Chapter 3 - https://www.cms.gov/Medicare/Eligibility-and-Enrollment/MedicarePresDrugEligEnrol/Downloads/CY_2019_PDP_Enrollment_and_Disenrollment_Guidance.pdf Garner and Sexton, Ballroom on 08212018 1040 and 1100 no repeats

Medicare Advantage 2019 Selected topics for discussion CMS Updates and Medicare Enrollment Period Changes and Medicare Advantage Updates 8/21/2018 Medicare Advantage 2019 Selected topics for discussion Center for Medicare and Medicaid Services Chicago Regional Office Raymond Swisher ARA, Division of Medicare Health Plans Operations August 2018 Garner and Sexton, Ballroom on 08212018 1040 and 1100 no repeats

Supplemental Benefits CMS Updates and Medicare Enrollment Period Changes and Medicare Advantage Updates 8/21/2018 Adult Day Care Home-based Palliative Care In-home Support Services Support for Caregivers Medically-approved Non-Opioid Pain Management Stand-alone Memory Fitness Benefit Garner and Sexton, Ballroom on 08212018 1040 and 1100 no repeats

Supplemental Benefits CMS Updates and Medicare Enrollment Period Changes and Medicare Advantage Updates 8/21/2018 Home and Bathroom Safety Devices Transportation Over the Counter (OTC) Benefits Garner and Sexton, Ballroom on 08212018 1040 and 1100 no repeats

Meaningful Differences CMS Updates and Medicare Enrollment Period Changes and Medicare Advantage Updates 8/21/2018 And some other changes coming in 2019 Garner and Sexton, Ballroom on 08212018 1040 and 1100 no repeats

MA Trends Enrollment Premiums Out of pocket expenditures CMS Updates and Medicare Enrollment Period Changes and Medicare Advantage Updates 8/21/2018 Enrollment Premiums Out of pocket expenditures Geographic Differences Garner and Sexton, Ballroom on 08212018 1040 and 1100 no repeats

Workgroup evaluating the MA Contract Termination Process SHIP COLLABORATION CMS Updates and Medicare Enrollment Period Changes and Medicare Advantage Updates 8/21/2018 Workgroup evaluating the MA Contract Termination Process Garner and Sexton, Ballroom on 08212018 1040 and 1100 no repeats